Mechanisms of Improved Outcomes for Breast Cancer between Surgical Oncologists and General Surgeons

Background. Prior multi-institutional studies have reported a survival benefit of breast cancer treatment by surgical oncologists (SO) over general surgeons (GS). Methods. Retrospective review tumor registry data of all breast cancer patients receiving primary treatment at a single institution from January 1, 1995, to December 31, 2008. Results. During the time period, there were 2192 patients who received primary breast cancer treatment at this institution. The mean age was 57 years and the mean follow-up was > 55 months. Stage distribution was similar between GS and SO. Overall survival (SO 83.8% vs. GS 75.6%) and disease-free survival (SO 80.7% vs. GS 72.0%) was highly statistically significant (P < 0.0001). For stages 1, 2a, 2b, 3a, and 3b there were statistically significant (P < 0.05) differences for overall and disease-free survival. Overall, the use of breast conservation was more likely by SO-52.6 vs. 38.3% all stages and 65.8 vs. 54.0% for stage 0-2. The compliance with all systemic therapies (chemotherapy and hormone therapy) was more likely if being treated by SO-77.3 vs. 68.5% (P < 0.02). The use of radiotherapy for breast conservation and in stage 3 mastectomy patients was higher for SO (P < 0.001). Participation in clinical trials was far higher for SO patients-56.2 vs. GS 7.0% (P < 0.001). Conclusions. The value added by having primary breast cancer treatment by a SO seems to arise from the more successful completion of multidisciplinary care in a timely fashion and higher rates of clinical trial involvement.